一种新的腹横肌平面阻滞用于结直肠手术后镇痛的效果。
The efficacy of a novel approach to transversus abdominis plane block for postoperative analgesia after colorectal surgery.
机构信息
Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
出版信息
Anesth Analg. 2011 Jun;112(6):1504-8. doi: 10.1213/ANE.0b013e3182159bf8. Epub 2011 Apr 5.
BACKGROUND
The analgesic efficacy of transversus abdominis plane (TAP) block has been established for patients undergoing abdominal surgery. We evaluated the efficacy of a novel approach to TAP block for postoperative analgesia after colorectal surgery.
METHODS
Forty adult ASA physical status I to III patients undergoing colorectal surgery were recruited to this double-blind randomized controlled trial. A standard general anesthetic technique was used. TAP block was performed at the end of surgery by piercing the transversus abdominis muscle from inside the abdominal wall at the midaxillary line at the level of the umbilicus with a 22-gauge blunt needle. The patients were randomly assigned to receive either 20 mL of 0.25%bupivacaine (TAP group) or normal saline (control group) on each side of the abdominal wall. Each patient was assessed at 0, 0.5, 1, 2, 4, 8, 12, and 24 hours postoperatively for pain at rest and on coughing using a visual analog scale. IV morphine was used for postoperative rescue analgesia. Time to first request for rescue analgesia, total morphine requirement in 24 hours, cumulative morphine consumption at 2, 4, 6, 12, and 24 hours, and adverse effects (respiratory depression, sedation, nausea/vomiting) were recorded.
RESULTS
A 65% decrease in 24-hour total morphine consumption was observed in the TAP group compared with the control group (P < 0.0001). The cumulative morphine requirement was also significantly lower in the TAP group at all time points. Although the time to first request for morphine was comparable, the subsequent doses of morphine were required at significantly longer time intervals in the TAP group than in the control group. TAP group patients had significantly lower pain scores at rest and on coughing as compared with the control group, at all time points assessed. The incidence of sedation was also less in the TAP group at 1, 2, 4, and 6 hours postoperatively (P < 0.05).
CONCLUSIONS
This new approach to the TAP block provides effective postoperative analgesia after colorectal surgery.
背景
腹横肌平面（TAP）阻滞在腹部手术后的镇痛效果已得到证实。我们评估了一种新的 TAP 阻滞方法在结直肠手术后的术后镇痛效果。
方法
本研究纳入了 40 名接受结直肠手术的 ASA 身体状况 I 至 III 级的成年患者，进行了这项双盲随机对照试验。采用标准全身麻醉技术。在手术结束时，通过在腋中线脐水平处用 22 号钝针从腹壁内侧刺穿腹横肌，进行 TAP 阻滞。患者被随机分配到腹壁两侧接受 20 mL 0.25%布比卡因（TAP 组）或生理盐水（对照组）。每位患者在术后 0、0.5、1、2、4、8、12 和 24 小时时评估静息和咳嗽时的疼痛程度，使用视觉模拟评分法（VAS）。术后给予 IV 吗啡进行解救性镇痛。记录首次要求解救性镇痛的时间、24 小时内的总吗啡用量、2、4、6、12 和 24 小时的累积吗啡消耗量，以及不良反应（呼吸抑制、镇静、恶心/呕吐）。
结果
与对照组相比，TAP 组 24 小时总吗啡消耗量减少了 65%（P < 0.0001）。TAP 组在所有时间点的累积吗啡需求也明显较低。虽然首次要求吗啡的时间相似，但 TAP 组随后需要的吗啡剂量在时间间隔上明显长于对照组。与对照组相比，TAP 组在所有评估时间点的静息和咳嗽时疼痛评分均显著降低。TAP 组在术后 1、2、4 和 6 小时的镇静发生率也较低（P < 0.05）。
结论
这种新的 TAP 阻滞方法为结直肠手术后提供了有效的术后镇痛。
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